Clinical efficacy of artery-first approach pancreaticoduodenectomy combined with venous resection and reconstruction for pancreatic head malignancies
10.3760/cma.j.cn115667-20250407-00043
- VernacularTitle:动脉先行路径联合静脉切除重建胰十二指肠切除术治疗胰头恶性肿瘤的临床疗效
- Author:
Xinyu LIU
1
;
Yining KANG
1
;
Shuai YUAN
1
;
Xiaohan SHI
1
;
Suizhi GAO
1
;
Xiaochao KANG
1
;
Kailian ZHENG
1
;
Shiwei GUO
1
;
Gang JIN
1
Author Information
1. 海军军医大学第一附属医院肝胆胰脾外科，上海 200433
- Publication Type:Journal Article
- Keywords:
Pancreatic neoplasms;
Pancreaticoduodenectomy;
Surgical procedures, operative
- From:
Chinese Journal of Pancreatology
2025;25(3):167-174
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.
